Nursing And Diabetes Essay

Patients with diabetes need to go steady what diabetes is. Patients who compreh stop over what diabetes is and the complicated process associated with the infirmity ar more(prenominal) likely to comply with the electropositive regimen. Diabetes Mellitus is a syndrome with dis tenacious metabolism and unconnected hyperglycemia due to either a deficiency of insulin secernment or to a combination of insulin resistance and inadequate insulin secretion to compensate (Davis, 2001). Diabetes is a continuing reform-minded malady that requires sustenancestyle changes, especially in the beas of nutrition and physical activity. The overall finishing of medical and nutritional therapy is to assist persons with diabetes in making self-directed behavi spontaneous changes that leave alone amend their overall health (Franz, 2012). rootage glucose monitoring and ends of riptide glucose monitoring interrogatory line glucose takes pre-meal and post-meal hobo divine service the uncomplaining with diabetes make better solid food choices, raise on how their bodies atomic publication 18 responding to specific foods. Patients should be taught specific directions for obtaining an adequate kindred seek and what to do with the numbers that they receive. Research has found that pertinaciousanimouss who reserve had education on the social occasion of their meters and how to interpret the data ar more likely to execute self-blood glucose monitoring on a regular stand (Franz, 2012). at that place ar m both different glucose monitors use suitable for tolerants. The tolerant demand to have a stratagem that is easy for them to use and convenient. A endurings visual distinctness and dexterity skills should be assessed prior to selecting a blood glucose monitoring device. A device is usually selected to bear the unhurrieds involve in collaboration with a diabetic educator at a health tending facility.The persevering postulate to be reminded to re cord the blood glucose value on a log air intende with the date and time and any associated signs and symptoms that he/she is experiencing at the time the specimen was obtained. This log should be sha cerise with his/her primary tuition practitioner.A discussion of glycosylated hemoglobin (HbA1c) should embarrass the reasons for doing the mental test, how it is performed and how the health attending practitioner lead interpret the data. These laboratory tests be orde blood-red on a routine basis along with an separate(prenominal) laboratory tests that atomic number 18 being monitored for the diligent of. A simple method acting to describe the HbA1c is to tell the patient that the test measures the amount of sugar that attaches to the protein in the red blood cell. The test shows the average blood sugar during the expiry tierce months. The advanceder(prenominal) the blood sugar the higher the HbA1c. The high blood sugar over a long period of time causes ravish to the large and small blood vessels on that pointfrom cast up the hazard of complications from diabetes.Medications and InsulinThe patient with diabetes needs to be reminded that the addition of medications to help succeed his/her diabetes is not because they are failing at diet counseling. Many patients with diabetes bring into being down(p) or despondent when they have to receive taking oral hyperglycemic medications and/or insulin. The instruct academic term should involve a bathvass of the different types of oral diabetic agents. A review of the different types of insulins and how to mix insulins should withal be discussed.Teach the patient nearly self-administration of insulin or oral agents as prescribed, and the grandeur of taking medications exactly as prescribed, in the appropriate dose (Davis, 2001). Patients should be provided with a make of signs and symptoms of hypoglycaemia and hyperglycemia and actions to sham in each situation.Complications from Diabe tesThe teaching regarding the complications encountered from diabetes should melody the effect of blood glucose control on semipermanent health (McGovern, 2002). The patient should be taught how to manage their diabetes when he/she has a nipper nausea, such as a cold, flu or gastrointestinal virus. The patient should as intimately as be taught how to watch for diabetic effects on the cardiovascular system, such as cerebrovascular incidents/stroke, coronary artery disease, and off-base vascular disease.Patients should be taught how to be supple for signs of urinary tract, respiratory tract infections and signs of nephritic disease. Assessment for signs of diabetic neuropathy should as well be included in the teaching invent. Diabetes is the confidential information cause of death by disease in the United States, it withal is a contributing factor in somewhat 50% of myocardial infarctions and about 75% of strokes as well as nephritic failure and peripheral vascular dis ease. Diabetes is besides the leading cause of new cecity (McGovern, 2002).Patients with diabetes should also receive education on the importance of smoking cessation, cholesterol and lipid precaution, blood pressure monitoring and way and management of other disease processes. disrobe and Foot CareTeach the patient to care for his feet by washing them daily, drying them guardedly curiously between the toes, and inspecting for corns, calluses, redness, swelling, bruises, blisters, and breaks in the skin. The patient should be advance to report any changes to his/her health care provider as in brief as possible. Advise the patient to wear non-constricting shoes and to avoid walking barefoot. The patient whitethorn use over-the-counter(a) athletes foot remedies to resume foot fungal infections and should be back up to call their health care provider if the athletes foot doesnt improve (McGovern, 2002). The patient should be reminded that he/she needs to treat all injuries, cuts and blisters particularly on the legs or feet carefully.Patients should be aware(predicate) that foot problems are a putting surface problem for patients with diabetes. Informing them of what to look for is an even sotful teaching concern. The signs and symptoms of foot problems to emphasize are feet that are cold, blue or ghastly in color, feet that are warm and red in color, foot swelling, foot annoyance when resting or with activity, weak pulses in the feet, not feeling pain although there is a cut or sore on the foot, shiny smooth skin on the feet and lower legs function and DiabetesA adjudge metric weight unit loss of ten to cardinal pounds has been known to improve hyperglycemia, dyslipidemia, and hypertension. The target goal for body weight for patients with diabetes is based on a reasonable or hearty body weight. Reasonable body weight is the weight an individual and health care professional ac familiarity as accomplishable and maintainable, both short-term and long-term (Franz, 2012, p.8). to a great extent emphasis is now placed on waist circumference, rather than on existent weight.A waist circumference greater than 40 inches in men and greater than 35 inches in women indicates a risk for metabolic disease. This is now part of what is referred to as metabolic syndrome. Reducing abdominal round out improves insulin sensitivity as well as lipid profiles. The benefits from carry out turn out from regular, long term, and aerobic cause. consummation utilise to summation muscle strength is an big doer of preserving and increasing muscular strength and endurance and is useful in helping to resist falls and increase mobility among the elderly (Franz, 2012). symmetric exercise apprise improve the functioning of the cardiovascular system, improve strength and flexibility, improve lipid levels, improve glycemic control, help moderate weight, and improve quality of life and self-esteem. Exercise increases the cellular glucose uptake by increasing the number of cell receptors. The following points should be considered in educating patients regarding generator an exercise program. Exercise program must be secern and built up slowly. Insulin is more cursorily bring ined when injected into a limb that is exercised, therefrom shtup result in hypoglycemia (Ferri, 1999).Patients need to be informed that exercise of a high intensity can also cause blood glucose levels to be higher after exercise than before, even though blood glucose levels are in the normal range before beginning exercise. This hyperglycemia can also report into the post-exercise state and is mediated by the counter-regulatory hormones (Franz, 2012, p. 62).The exercise program should include a phoebe bird to ten minute warm-up and cool-down session. The warm-up increases core body temperature and prevents muscle tarnish and the cool-down session prevents blood pooling in the extremities and facilitates remotion of metabolic by-products. Research studies show there are similar cardiorespiratory benefits that carry on when activity is done in shorter sessions, ( near 10 minutes) accumulated throughout the day than in activity sessions of prolonged sessions (greater than 30 minutes) (Franz, 2012). This is an important factor to emphasize with patients who dont think they have the time and readiness for exercise.Diet and DiabetesThe American Diabetes Association (ADA) has build up nutritional guidelines for patients with diabetes. Their focus is on achieving optimal metabolic outcomes related to glycemia, lipid profiles, and blood pressure levels. Patients with diabetes need to maintain a healthy diet consisting of triplex servings of fruits, vegetables, integral grains, low-fat dairy products, fish, lean meats, and poultry (Franz, 2012). The permutation diet of the ADA includes protein, bread, fruit, milk, and low and average clams vegetables (Ferri, 1999).The food/meal plan is based on the individuals appe tite, preferred foods, and usual schedule of food dream and activities, and cultural preferences. Determination of thermal needs varies considerably among individuals, and is based on present weight and current level of energy. Required calories are about 40 kcal/kg or 20 kcal/lb per day for adults with normal activity patterns (Davis, 2001). accent should also be placed on maintaining a consistent day-to-day carbohydrate intake at meals and snacks.It is the carbohydrates that have the sterling(prenominal) impact on glycemia. A number of factors influence glycemic responses to foods, including the amount of carbohydrate, nature of the simple sugar components, nature of the starch, cooking and food processing, and other food components (Franz, 2012, p.13). Maintaining a food daybook can help identify areas of weaknesses and how to machinate better menu plans.Recommendations for fiber intake are the same for patients with diabetes as for the familiar population. It is recommend ed that they increase the amount of fiber to approximately 50 grams per day in their diet. indissoluble and soluble globular fiber balk glucose absorption and attenuate the postprandial blood serum glucose peak, they also help to lower the deluxe triglyceride levels often present in torrential diabetes (Ferri, 1999). The discussion of diet management should also include a discussion of alcoholic beverage intake. Precautions regarding the use of alcohol that apply to the familiar public also apply to pack with diabetes. Abstaining from alcohol should be advised for pile with a history of alcohol abuse, during pregnancy, and for race with other medical conditions such as pancreatitis, advanced neuropathy, and elevated triglycerides.The effects of alcohol on blood glucose levels is dependent on the amount of alcohol ingested as well as the relationship to food intake. Because alcohol cannot be used as a source of glucose, hypoglycemia can result when alcohol is ingested with out food. The hypoglycemia can keep from eight to twelve hours after the last drink of alcohol. When alcohol is ingested in moderateness and with food, blood glucose levels are not touch on by the ingestion of moderate amounts of alcohol. If the patient plans to consume alcoholic beverages they are to be included in the meal plan. The patient should be reminded that no food should be omitted because of the possibility of alcohol induced hypoglycemia (Franz, 2012).head with DiabetesThe patient needs to understand that the diagnosis of diabetes mellitus as with any continuing illness can be unanticipated and potentially devastating. Grief is the most habitual chemical reaction of an individual diagnosed with diabetes. Resolution of the grief is dependent on variables such as education, economics, geography, and religious and cultural factors. The support of family and friends requires the long-term acceptance of the disease progression. Patients need to be aware that depressio n is common with chronic diseases such as diabetes. The depression should be recognized and treated as soon as possible since depression can affect glycemic control and complicate the management of the diabetes (Buttaro, 2008).The patient needs to understand that diabetes is a lifelong disease process that requires a lifetime commitment and lifestyle changes. The patient should be educated about sanction having the resources and knowing how and when to use them. The skills of empowerment that help the patient reflect on life satisfaction in the following areas physical, mental, spiritual, family related, social, work related, financial, personal.The patient should be encouraged to establish goals which emphasize at least cardinal of these areas in which he/she has control. In the session of coping with diabetes the patient should be support to develop better problem understand skills, which are necessary to manage a life-long disease such as diabetes. Coping with diabetes shoul d also include stress management concepts. Stress management concepts should include a definition of stress, the bodys reaction to stress, the effects of stress on diabetes management, identifying stressors, identifying methods of coping, relaxation exercises and identifying support systems to tap into.Management of the disease process should include eliminating or minimizing other cardiovascular risk factors for example blood pressure control, lipid control, and smoking cessation. Patients with diabetes should also be instructed on what to do when they become sick with a cold, flu, gastrointestinal virus, or other minor illness. They need to be aware that these minor illnesses can affect their diabetes and blood glucose levels (McGovern, 2002). Instruction on what to do when they become ill and the importance of continuing to take their diabetes medications and/or insulin and other frequent care should be discussed.Some radical guidelines for management during an illness or sick -day include maintain adequate hydration because of the risk of drying up from decreased fluid intake, polyuria, vomiting, diarrhea, and evaporative losings from fever. Patient should be instructed to drink at least eight ounces of calorie unload liquids every hour plot they are awake. The beverages should be caffeine-free, since caffeine acts as a diuretic and can actually increase the chances of hypovolemia. If the patient is unable to tolerate fluids by mouth, antiemetic suppositories or intravenous fluids may be required. Vomiting that is persistent and heady may require emergency populate care. The patient should be encouraged to perform blood glucose monitoring more much while he/she is ill and to depart urine ketone monitoring with urine dipsticks, during the illness (Franz, 2012).The patient should be instructed to continue taking his/her insulin and/or oral antidiabetic agents while ill and even when unable to eat. The neglect of insulin is a common cause of ketone mia and can result in a serious condition called diabetic ketoacidosis. The patient should be given a list of foods that contain fast acting carbohydrates that they can consume when they experience signs and symptoms of hypoglycemia.Patients should be encouraged to seek regular ophthalmologic examinations to detect for diabetic retinopathy. Regular dental examinations should also be encouraged to evaluate to potential areas that can become infected and possible oral lesions.Summary The teaching program for the patients with diabetes is intentional to be held for six sessions. However, the sessions can be lengthened or shortened to meet the needs of the intended audience. These two to three hour sessions allow the patient to absorb the material that is being taught and to be able to ask questions. The learning needs are focused on managing their glucose levels and preventing complications of diabetes. The patient needs to be educated on the multiple disease processes associated with diabetes and the factors affecting each of these areas.The patient also needs to have the knowledge of how to manage their diabetes when they are ill and admonition signs that they are hypo/hyperglycemic. Diabetic patients should be advised to contact their health care provider any time they are unsure what to do or have questions on how to manage their disease. There are many teaching handouts and pamphlets that are uncommitted free of charge from the various agencies. These handouts are available on a vast variety of subjects that can be used with the teaching plan. The evaluation criteria for the teaching plan would include an evaluation tool in which the patients could complete anonymously at the end of the program.ReferencesButtaro, T.M., Trybulski, J., Bailey, P.P., Sandberg-Cook, J. (2008).Primary Care A collaborative Practice, 3rd. Edition. Philadelphia, PA Mosby, Inc.NO Davis, A. (2001). Adult guard Practitioner Certification Review. Philadelphia, PA Mosby, Inc.Ferri, F. (2012). clinical Advisor Instant Diagnosis and Treatment. Philadelphia, PA Mosby, Inc.NO Franz, M. (Ed.) (2001). Diabetes Management Therapies A nerve Curriculum for Diabetes Education. 4th Edition. Chicago, IL American Association of Diabetes Educators.Franz, M. (2012). American Diabetes Association deal to Nutrition Therapy for Diabetes, 2nd Edition. Alexandria, VA American Diabetes Association.Herfindal, E. and Gourley D. (2000). textbook of Therapeutics Drug and Disease Management. Seventh Edition. Philadelphia, PA Lippincott Williams and Wilkins.NO McGovern, K., Devlin, M., Lange, E., and Mann, N. (Eds.) (2002). Disease Management for declare Practitioners. Springhouse, PA Springhouse Corporation.